A novel workflow for developing 3D mitral valve-left ventricular model using 3D-Transesophageal echocardiography

Mitral valve (MV) repair is the preferred method of correcting mitral valve regurgitation. Realistic analysis of MV function and prediction of successful repair should include both the left ventricle (LV) and the MV to capture their coupled behavior. However, simultaneous imaging and processing of LV and MV has been a challenge. We present a novel and efficient method to convert transesophageal echocardiography (TEE) images into virtual 3D models for enhanced visualization and predictive flow modeling to assist with presurgical planning. A total of 5 pigs were anesthetized prior to obtaining 3D TEE. Resulting DICOM data was processed using Slicer software. MV anatomy while maximally opened was segmented using its Valve Segmentation tool. LV anatomy at the start and end of diastole was segmented in Slicer. The MV was smoothened and converted into a shell in MeshLab then unified with the LV using Meshmixer. 3D models generated with our workflow were validated against the harvested MV and LV tissue. The generated 3D model of both MV and LV at end diastole geometrically reasonable correlation with the harvested sample. Unified anatomically accurate virtual models of the MV-LV for each animal throughout diastole were successfully developed. Virtually, the annular circumference, LV length from annulus to apex, posterior MV leaflet, anterolateral leaflet, and anteromedial leaflet were 11.8, 5.1, 1.9, 1.8, and 1.7 cm. Anatomically, the corresponding measurements are 8.6, 6.0, 1.4, 1.0, and 1.1 cm. In conclusion, we have developed an efficient, relatively automated workflow to create 3D models of MVs and LVs for hemodynamic modeling and visualization. This algorithm and 3D protocol may help to improve our mitral valve understanding prior to planning surgical repair.